Anticoagulant medication adherence for cancer‐associated thrombosis: A comparison of LMWH to DOACs

Abstract

It is not clear if patients are less adherent to low molecular weight heparin (LMWH) compared to direct oral anticoagulants (DOACs) for cancer‐associated thrombosis (CAT). We evaluated medication adherence among two propensity‐matched groups of patients with CAT by comparing the proportion of days covered (PDC). Median treatment persistence on DOACs was more than 80 days longer than LMWH. Medication adherence was high (~95%) and was similar with LMWH compared to DOACs. Abstract BackgroundLow molecular weight heparin (LMWH) and direct oral anticoagulants (DOACs) are used to treat cancer‐associated thrombosis (CAT). It is not clear if patients are less adherent to LMWH compared to DOACs. ObjectivesTo compare medication persistence and adherence between LMWH and DOACs. Patients/MethodsWe analyzed Optum's de‐identified Clinformatics® Data Mart Database of privately insured adults with cancer diagnosed between January 2009 and October 2015 who were undergoing chemotherapy, immunotherapy, targeted or hormonal therapies; developed CAT; and were treated with an outpatient anticoagulant. The proportion of days covered (PDC) was calculated from the date of anticoagulant prescription until the anticoagulant was switched, stopped, or the study end. Medication adherence was defined as PDC ≥ 80%, ≥95%, and by comparing the mean PDC. ResultsTwo propensity‐matched groups of 1128 patients were identified. Patient persistence was higher with DOACs compared to LMWH (median 116 days versus 34 days). With adherence defined as PDC ≥ 80%, we found no significant difference (95.6% versus 94.6% adherence with DOACs versus LMWH, P = .33). The mean difference of PDC between the two groups was also similar. With medication adherence defined as PDC ≥ 95%, adherence was evident in 73% of DOAC users and 81% of patients on LMWH (P < .001). Prescription copayments were higher on average for LMWH compared to DOACs (mean $153.61 versus 40.67; standard deviation $306.74 versus $33.11). ConclusionPatients remain on DOACs longer than LMWH, but medication adherence is similar with LMWH.

Cancer‐associated venous thromboembolism in Israel: Incidence, risk factors, treatment, and health care utilization in a population based cohort study

“…VTE has traditionally been treated in patients with cancer with LMWH; however, recent studies show that rivaroxaban is associated with lower hospitalizations, length of stay, emergency room visits, and outpatient visits as compared to both LMWH and warfarin 66 , 67 and may also have the added value of increased adherence 68 and persistence. 69 …”

Adherence to apixaban for extended thromboprophylaxis after major abdominal or pelvic surgery for cancer: A prospective cohort study

“…There is hence information from studies with different DOACs attesting to the good adherence after abdominal or pelvic surgery for cancer. The adherence was also compared between DOACs and LMWH in patients with cancer‐associated thrombosis in an analysis of the Cliniformatics® Data Mart claims database 19 . Persistence with the treatment dose of DOAC was 116 days versus 34 days with LMWH, whereas PDC did not differ between the medications.…”

Arguments for Using Direct Oral Anticoagulants in Cancer-Related Venous Thromboembolism

“…Early this year, Schaefer et al showed a similarly high rate (95%) of LMWH and DOAC adherence for patients with CAT. Thus, the authors recommend that anticoagulant therapy should not be guided by the probability of treatment compliance [5].…”

“…Recently, the standard of care of cancer-associated VTE consisted of subcutaneous low-molecular-weight heparin (LMWH) for an initial duration of 6 months, which was extended with either LMWH or vitamin K antagonists (VKA) for an indefinite duration, i.e., until the cancer was considered to be in remission [4]. The administration of LMWHs faces a series of drawbacks connected especially with the manner of administration, which leads to a decrease in treatment compliance and an increase in the risk of VTE recurrence [5].…”